Inspection on 19/07/09 for Ashfields Care Home

This inspection was carried out on 19th July 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashfields Care Home 27/11/09

Ashfields Care Home 21/05/08

Ashfields Care Home 23/05/07

Ashfields Care Home 24/05/06

Ashfields Care Home 13/12/05

Ashfields Care Home 16/08/05

Ashfields Care Home 22/02/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Ashfields Care Home Ashfields 129 Prestbury Road Macclesfield Cheshire SK10 3DA Lead Inspector David Jones Key Unannounced Inspection 19, 23 and 29 June 2009 09:50 DS0000062416.V376327.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashfields Care Home Address Ashfields 129 Prestbury Road Macclesfield Cheshire SK10 3DA 01625 617288 01625 434753 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Winnie Care (Macclesfield) Ltd Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 39 service users in the category of OP (old age, not falling within any other category) 21 May 2008 Date of last inspection Brief Description of the Service: Ashfields is a privately owned care home located close to Macclesfield town centre. There are a variety of shops, a church and other facilities nearby. Ashfields is a three-storey building and residents are accommodated on all floors. Access between floors is via a passenger lift or the stairs. Residents’ accommodation currently consists of 39 single rooms, 24 of which have ensuite facilities. Included in these numbers are five flats which are in the grounds of the home; these are linked to the main building via an emergency call system. The people who live in the flats are more independent than those accommodated in the main building. There is a lounge, conservatory and a separate dining room available for the people who live in the home. The current weekly charges for the home are £460.00 to £499 for the flats. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero stars. This means that people who use this agency experience poor quality outcomes. This visit was unannounced. It took place over three days, taking sixteen hours in total, and was done by one inspector. This report will say we when referring to our activities and findings, as it is written on behalf of the Care Quality Commission. Our visit was just one part of the inspection. Before the visit took place we asked the manager to complete a questionnaire that we call an annual quality assurance assessment or AQAA for short. It gives us information about how the service is meeting the needs of the people who use it and includes plans for future development. We made survey questionnaires available for the people who live at the home, their relatives and staff. Replies we received have been taken into account in the report. We also looked at the information that we already had about the home and this, with the information from the AQAA, helped us to form our inspection plan. We checked the records of three people who lived at the home to see what care they receive. We spoke with them, some of their relatives and the staff who support and care for them and their views were taken into account. We looked at the communal areas of the home, including lounges, kitchen, bathrooms and toilets to see at how the home was decorated, maintained and furnished. We also looked at some policies and procedures to check that these were up to date and provided suitable guidance for staff. What the service does well: The people who live at Ashfields Care Home and those who are thinking of moving in are given good information to help them make decisions about the home. The information about the home, what it does and who it is for, is clearly written and available in large print so people are helped to understand the information and know what the home provides. Two people who had recently moved in told us that the information they were given was very good. They were invited to visit the home before they moved in so they could make sure it was suitable for them. This showed us that managers and staff understand the importance of providing people who wish to live at the home with the information they need to help them choose a home that is suitable for them. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 6 The home had a relaxed, friendly and welcoming atmosphere. We could see that people were supported to follow personal interests and activities. For example one person enjoyed amateur radio and had an impressive range of equipment set up in their room. Another person was a collector and had gathered a large collection of ornaments which were on display in their room. People who live at Ashfields went out regularly so they were part of the local community. One person told us they were going to a coffee morning, another had an arrangement to go shopping every Friday and a large group were going out to visit a local attraction. People told us that they had recently been on holiday supported by staff and outings were offered on a regular basis. We were told that a local priest visited regularly to give Communion for those who required it and there was a monthly service held at the home. Some people go to church on a regular basis and others pray in the privacy of their own rooms. One person told us that their religion was very important to them and they were able to go to church when they wanted to. This showed us that the religious needs of the people who live at the home were met. We could see that people were able to please themselves and their choices were respected. Care staff were observed to be caring and sensitive in their approach. We could see that staff respected people’s wishes regarding rising and retiring and they tried to promote choice in all aspects of daily living. What has improved since the last inspection? At our last inspection we found that care plans for people living at the home did not always provide sufficient information about the person’s needs or the way the wanted things to be done. We could see that this was being addressed and significant improvements had been made. Care plans had more information about the person’s individual needs, wishes and personal preferences so they would receive care and support in the way they wanted and preferred. This made sure that people received the help they needed and their independence was recognised and promoted just as they wanted it to be. Communication with health and social care professionals had also been improved so appropriate arrangements were made for people to receive treatment and advice from health care professionals as and when they needed it. All staff we spoke with had a good knowledge of each persons health care needs. Care records showed that each persons health care needs were monitored and where necessary, care staff had made contact with the person’s health care professionals so their health care needs were met. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 7 What they could do better: We were concerned to find that the home was not being managed properly. There was a lack of staff supervision and discipline. We found that a number of staff, including senior staff, had witnessed abuse of vulnerable people but managers had not taken approriate action to put things right. We reported our concerns to the local social services and we required managers to ensure that the home is always conducted in a manner which respects the dignity of people who live there. We also required them to make approriate arrangements including the training of staff to ensure that any evidence or suspicion of abuse is acted upon and reported to the social services department and where appropriate the police without delay. This will ensure that the people who live at the home are safeguarded from abuse. We were also concerned to find that a person had moved into the home without having their needs checked by staff from the home before they moved in. As time passed it became clear that the home was not suitable for the person and their needs were not being met. We have required managers to make sure that people do not move into the home until their needs have been assessed by an appropriately qualified person so people can be confident that the home is suitable for them before they move in. We found that the home’s staff recruitment procedures were not thorough enough and we required managers to make sure that all approriate checks and references were in place before new staff are allowed to start work in the home. This will help to make sure that new staff are suitable to work with the people who live at the home so they are safe and safeguarded from abuse. Improvements need to be made to the staff training programme. Staff training records had been misplaced and there was evidence of gaps in staff training, which may put the people who live at the home at risk of their needs not being met in a safe and approriate way. We have required managers to make sure that the care staff get training appropriate to the duties they are to perform so they have the knowledge and skills they need to carry out their work safely and effectively. The area manager of the organisation that runs the home took immediate action to address the issues we raised during the inspection and provided us with a copy of the home’s improvement plan. This showed us that the managers work well with us and know what to do to make the necessary improvements to the way the home is run. We will make follow up visits to the home to check that satisfactory progress is being made. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking of moving to Ashfields are provided with clear information so they can make a choice about the home’s suitability for them. A lack of care needs assessment meant that the home provided accommodation and care to a person who had needs which the home could not meet. EVIDENCE: We could see that managers and staff understand the importance of providing people with the information they need to help them choose a home that is suitable for them. One of the people living at the home told us that the information they were given was very good. They had visited the home before they decided to move in so they could see for themselves whether the home Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 11 was suitable to meet their needs. The information about what how the home works and who it is for (the statement of purpose and service users guide) were written in large print and plain and clear language so people were helped to understand what the home had to offer. We checked the records of four people who lived at the home. We could see that three of these people had their needs assessed before they moved in so they could be confident that their needs would be met. However, we were concerned to find that one person had moved in before staff had assessed their needs. Records showed that the person presented with needs that were outside the home’s conditions of registration. The staff team did not have the right experience, skills or capabilities to meet the person’s needs so the person’s needs were not met. This showed us that the home’s assessment and care planning procedures needed to be improved so all people thinking of moving to the home can be confident that their needs will be met when they move in. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were generally well written so that the health and personal care that people received was based on their individual needs. The principles of dignity and respect were not always promoted so some people who lived at the home had been treated disrespectfully by some of the staff. EVIDENCE: We looked at the personal care records of four people who lived at the home. Each person had a care plan. The manager told us that care plans were always written with the person but none of the people we spoke to were aware of their care plans and none had been invited to sign or agree their care plans so we could not confirm this. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 13 We could see that improvements had been made in the way care plans were written because they were more person centred so people would receive care and support in the way they wanted and preferred. For example one person we spoke to was very independent and it was very important to them that the staff recognised this. Their care plan was good because their wishes and capabilities were made clear so staff knew that they only needed to offer limited assistance in some circumstances. This made sure that the person got the assistance they needed and their independence was recognised and promoted just as they wanted it to be. All the care plans we looked at had been reviewed monthly and most had been kept up to date. However, there was still room for improvement. For example one person’s care plan had not been revised when their condition had deteriorated and their needs had changed. Their care plan did not mention that they needed help from staff to put their support stockings on. This person told us that some staff were better at doing this than others and if it was not done properly, they would be uncomfortable. They explained that there was a particular way of putting their stockings on which some staff didn’t know about. This showed us that this person’s care plan needed to be updated with their needs and personal preferences so staff will know how to meet their needs in the way they want and prefer. All staff we spoke with had a good knowledge of each persons health care needs. Care records showed that each persons health care needs were monitored and where necessary, care staff made contact with their health care professionals so their health care needs were met. We checked the medications and saw that people received their medicines as their doctor prescribed them. However, we could see that stock records of loose medicines needed to be improved so managers and staff could make effective stock checks of all medicines kept in the home. The manager told us that all senior staff had received training in the administration, recording and safe storage of medicines in the home in the last 12 months but the home’s staff training records had been misplaced so we could not confirm this. The manager told us that all senior staff had been booked on refresher training to make sure that they had the right skills to administer medicines safely and ensure people’s health care needs are met. We could see that people enjoyed good relationships with most of the staff and we observed staff providing care and support in a considerate manner, being sensitive to each person’s individual needs. However, some people told us that they were not always treated with respect and several members of staff told us they had witnessed other staff being verbally and physically abusive to people who lived at the home. Staff had reported their concerns to management but found that the behaviour of these staff was allowed to continue unaddressed. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 14 This showed us that the home was not always managed in a way that would promote dignity and respect of the people who lived there. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are able to make choices about their lifestyle, social activities and food so they have control over their lives. A varied and nutritious diet is on offer but people living at the home find there is a lack of choice for the evening meal. EVIDENCE: The home had a relaxed, friendly and welcoming atmosphere. The home’s activity records were not up to date but most of the people we spoke to were happy with the range of activities available. We could see that people were supported with their individual hobbies and interest. For example one person enjoyed amateur radio and had an impressive range of equipment set up in their room. Another person was a collector and had gathered a large collection of ornaments which were on display in their room. We could see that some people went out regularly. One person told us they were going to a coffee morning, another had an arrangement to go shopping and a large group were Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 16 going out to visit a local attraction. People told us that they had recently been on holiday supported by staff and outings were offered on a regular basis. One person told us that they had nothing to do other than sit in the lounge each day. They told us that they had not been asked about activities so no arrangements had been made for them. We looked at their care plan and we could see that the sections on activities had not been completed. The manager told us that this was an oversight and would make arrangements to develop an approriate care plan with the person. People told us that local clergy visit regularly to give Communion for those who require it and there is a monthly service held at the home. Some people go to church regularly. One person told us that their religion was very important to them and they were able to go to church when they wanted to. This showed us that the religious needs of the people who live at the home were met. We could see that people were able to please themselves and their choices were respected. Care staff were observed to be caring and sensitive in their approach. We could see that they respected people’s wishes regarding rising and retiring and they tried to promote choice in all aspects of daily living. Meal times were enjoyable social occasions. Some people told us that they were happy with the meals served in the home but others said there was a lack of variation and choice particularly at teatime. The manager told us that this had been discussed at a recent residents’ meeting and the cook and area manager were working together to explore how the menu could be improved to offer more choice. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns were not always acted upon so vulnerable people were not safeguarded from abuse and abusive practices of some of the staff. EVIDENCE: Ashfields Care Home has a complaints procedure that provides clear guidance on how to make a complaint and it is available in large print so it is easier to read. Most of the people we spoke with told us that they knew how to make a complaint and who to speak to if they were unhappy. The complaints records showed that the home had received six complaints in the 12 months before our inspection. We could see that some of the complaints had been addressed in full but it was not clear what had been done about others because there was no record of the action taken or the outcome of the investigation. Some people told us that they were satisfied with the way their complaints had been handled but other people told us they were not always listened to. One person told us that they had made complaints but we found no mention of their complaints in the complaints records. The home needs to make sure that all complaints are recorded in full with details of action taken to address the concerns raised and feedback to the person who Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 18 made the complaint. This will help to make sure that people are listened to so they can be confident that their concerns will be taken seriously and acted upon. Ashfields Care Home has polices and procedures for responding to suspicion or evidence of abuse or neglect including a “whistle blowing policy” so staff know that they can report poor practice. There had been five safeguarding referrals to the local authority since our last inspection at Ashfields. Information provided by the local social services department showed us that managers and staff had worked in partnership with them to address these issues and ensure that vulnerable people were safeguarded. However, we found that a number of staff, including senior staff, had witnessed abuse of vulnerable people but managers had not taken approriate action to put things right. Several instances of alleged abuse were not reported to the local authority under locally agreed adult safeguarding procedures so vulnerable people were not protected from the alleged abusive practices of some of the staff. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained so that it provides clean and comfortable accommodation that meets people’s needs and expectations. EVIDENCE: The people who live at Ashfields care Home told us that they were happy with the accommodation and comfortable in their surroundings. They live in a clean, fresh and well maintained home which meets their needs and expectations. We could see that people were encouraged to personalise their bedrooms with their own possessions and decorate them to suit their personal preferences and taste. For example one person had equipped their room with a large and impressive citizen band radio so they could pursue their hobby and Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 20 another person had racked out their room with shelving to house their extensive collection of ornaments. This provides for a homely and comfortable environment. The home had a programme to improve fixtures fittings and internal decoration. Since our last inspection there some of the bedrooms had been decorated and re-furnished with new wardrobes and new curtains. Maintenance records showed that electrical and gas installations, hoists and fire prevention equipment are serviced regularly so people are safe. The standard of cleanliness throughout the home was good. There were no noticeable odours and polices and procedures on infection control were in place and followed by staff. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A lack of effective staff training and poor discipline of some of the staff meant that some of the people who lived at the home were not always protected from abuse. The home’s recruitment procedures were not always thorough so managers could not be confident that all staff employed at the home were suitable to work with the people who lived their. EVIDENCE: We could see from our observations that staff working in the home were experienced in caring for older people. They carried out their work in good humour and with sensitivity for each person’s needs so they received care in the way they would prefer. Staff rotas and our observations showed us that there were enough staff on duty to meet the needs of the people who lived at the home. Staffing rotas take into account the changing needs of people and more staff are employed at times of higher demand. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 22 Most of the people who live at Ashfields Care Home were generally satisfied that the care they received met their needs but some people told us their needs were not always met and others told us they were not always treated with respect by all the staff. Several care staff told us that there was a lack of discipline from some of the staff. They told us they had witnessed abuse and abusive practices and reported these issues to managers but the managers had not taken approriate action to safeguard people and make things right. The alleged perpetrators of abuse had been allowed to continue with their duties unchecked so vulnerable people remained at risk of abuse. This showed us that the staff team were not being managed effectively and there was a lack of staff discipline and supervision. The manager and area manager told us that they recognise the importance of staff training and try to provide a training programme that will ensure that staff have the skills they require to meet people’s needs in safe and approriate way. All new staff were expected to complete the “Skills for Care” induction training programme. This includes the common induction standards so new staff can gain the skills they need to carry out their work safely and effectively. However, one staff member told us that they had not done any training other than being shown how to take people to the toilet, empty commodes and get people to bed. Their training records indicated they had done moving and handling and falls prevention but there was no evidence that they had covered the other important aspects of care including infection control, health and safety and safeguarding vulnerable people. The personnel file for one other staff member contained no training records, certificates or any other evidence that they had done any training whatsoever. Staff told us that they were aware that some staff had not had recent training in moving and handling and others had not had training in safeguarding vulnerable people. A senior staff member told us that they had not had training in risk assessment and they were not confident in their abilities to carry out risk assessment effectively. This showed us that there were gaps in the home’s staff training programme. The manager told us that she was aware of gaps in staff training and was working with the area manager to identify approriate training for staff. The manager also told us a lot of training had been done in the last 12 months but the staff training records had been misplaced and were unavailable so we were not able to make a proper assessment of this. Only three of the 17 care staff working at the home had achieved a nationally recognised qualification (NVQ) in care at level 2 or above. However three other staff were working towards the qualification and another two were waiting to register. NVQs are nationally recognised qualifications for staff in the care profession. This means that the home is on target for a minimum of 50 of staff to achieve a nationally recognised qualification in care. This will help to make sure that the people who live at the home are in safe hands. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 23 We checked the records of two staff who worked at the home. We could see that the home had good procedures for recruiting staff but these had not always been followed completely. The manager had allowed a person to start work at the home before their Criminal Records Bureau disclosure had been received because the vacancy needed to be filled. This can happen if all other approriate references, checks and clearances were in place before the staff member was allowed to work with people who lived at the home. Records showed that some of the necessary documentation was in place but there was no reference from the person’s last care employer and checks had not been made to verify their reason for leaving the post. This showed us that the home’s recruitment checks were not thorough enough to make sure that the new employee was suitable to work at the home. This meant that the people who lived at the home were not always adequately safeguarded. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was not being managed effectively. Polices and procedures designed to safeguarded vulnerable people from abuse including verbal, physical and financial abuse were not put into practice so vulnerable people were not safe and remained at risk of abuse. Staff were not being effectively supervised and there was a lack of staff discipline so people were not always treated with respect. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 25 EVIDENCE: There had been a change of manager since our last inspection of the home. The new manager has more than sixteen years experience working in the field of social care including 12 years working as deputy manager at the home. She is not yet registered with the Care Quality Commission but intends to make application in the near future. In her experience she has developed her skills and has acquired NVQ levels 2 and 3 in social care and is undertaking NVQ level 4 and the registered manager’s award. The management structure is suitable for the size and purposes of the home but there was evidence of a lack of staff supervision and discipline. For example: the social services department undertook an investigation into allegations of abuse raised by staff during our visit to the home. They found evidence that senior staff and managers had been aware of abuse done by and abusive practices of some of the staff but had not taken appropriate action to safeguard vulnerable people. This meant that the people who lived at the home had remained at risk of abuse for some time and the alleged unsatisfactory and inappropriate practices of some of the staff remained unchecked. In addition it was found that junior staff who were untrained in administration of medication had been asked to give people their medication. This had resulted in medication errors and people not getting their medication as their doctor prescribed it. This meant that their health care needs were not met. This showed us that the staff team was not being supervised and managed effectively so the home was not managed in the best interests of the people who lived there. There is a quality monitoring system, which seeks to involve people who live at the home in measuring quality and making a positive contribution to home’s development. However, the manager told us that this was not being put into practice fully. A residents’ meeting had been held but the home’s quality survey questionnaire had not been circulated in over 12 months and there was no report on quality issues. Quality checks had been instigated following a senior staff meeting in April this year but these were not recorded so they were of limited value. People who lived at the home told us that they did not recall being asked about quality issues. They told us that they had raised concerns about the lack of variety in the evening meal but did not feel that their views had been taken on board. The home’s quality assurance systems needs to be put into practice fully so people will know that their views are taken seriously and acted upon. Consideration should be given to widening the scope of the home’s quality assurance system to include checks on the quality of assessments, risk assessments, care plans and outcomes for the people who live at the home. This will help managers to address some of the care management issues identified during this inspection. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 26 People who live at the home are able to deposit money in the home’s safe and staff will assist them with their shopping by running errands and making purchases on their behalf. Staff keep records of all transactions but people were not fully protected from financial abuse because staff did not get or keep receipts. Clear financial and accounting procedures need to be established so staff understand the way things should be done to protect themselves from accusation and protect the financial interests of the people who live at the home. All electrical circuits, portable electrical appliances, lift, hoist, fire detection, and fire fighting equipment had been serviced within the approriate timescale so people living and working in the home were safe. Risk assessments were carried out to make sure working practices were safe and significant findings were recorded. Where risks to health and safety were identified risk management plans were in place so risks to health and safety were minimised and people were safe. However we could see that some risk assessments needed further development to make sure all hazards to health and safety were identified and managed effectively. For example a number of risk assessments on prevention of pressure sores had errors in the calculations. This meant that they gave the wrong score indicating, which resulted in some people being identified as not at risk of developing pressures sores when they were. The senior staff member who completed these risk assessments told us that she had never had training on risk assessment and was not confident that she had the skills to do them right. Winnie Care (Macclesfield) Ltd, the company that owns and operates the home, is committed to promoting equality and diversity so the differing needs, personal preferences and cultural requirements of all people who may wish to use the home are recognised, respected and met. This was not fully reflected in the home’s statement of purpose or service users guide. The area manager told us that the statement of purpose and service users guide would be amended to reflect the home’s commitment to equality and diversity. Equality and diversity is promoted in the home by recognising and addressing people’s differing needs through care planning but some staff have not received training on equality and diversity. Arrangements should be made to make sure that all staff have the knowledge and skills they need to acknowledge, understand and cater for each individual’s needs including those relating to their religious and cultural needs, personal preferences, sexuality and sexual orientation. We could see that the manager is person centred in her approach and has good relationships with the people who live at the home. She is committed to making improvements to the general management of the home so the home is run in the best interests of the people who live there. The area manager took Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 27 immediate action to address the issues we raised during the inspection and provided a copy of the home’s improvement plan. This showed us that the managers work well with us and know what to do to make the necessary improvements to the way the home is run. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 1 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 1 1 2 Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Care and accommodation must not be provided to a person at the care home unless the needs of the person have been assessed by a suitably qualified individual, a copy of the assessment has been obtained, there has been approriate consultation with the person or their representatives and they have received written confirmation that the home is suitable to meet their personal care, health and welfare needs. This is to make sure that the home is suitable to meet people’s needs. 2 OP10 12 The home must always be conducted in a manner which respects the dignity of people who live there. This will ensure that the people who live at the home are always treated with respect. 3 OP18 13 (6) Arrangements must be made, including the training of staff to DS0000062416.V376327.R01.S.doc Timescale for action 24/08/09 24/08/09 24/08/09 Page 30 Ashfields Care Home Version 5.2 ensure that any evidence or suspicion of abuse is acted upon and reported to the social services department and where appropriate the police without delay. This will ensure that the people who live at the home are safeguarded from abuse. 4 OP29 19(10)(b) Staff must not begin providing 24/08/09 care in the home until full and satisfactory information is received in respect of them. This must include a written reference from their previous employer where the individual worked in a position with vulnerable adults and verification of the reason why they ceased to work in that position. This will make sure that people are safe and safeguarded from abuse. (Previous timescale 25/06/08 was not met.) Make sure that the care staff get training approriate to the duties they are to perform including training on Safeguarding vulnerable people, medication, moving and handling, infection control, risk assessment and heath and safety at work. So staff have the training and skills they need to carry out their work safely and effectively. A record of all staff training, including induction training in the home, must be kept and be available for inspection at all times. This will help to ensure that staff Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 31 5 OP30 18 24/08/09 6 OP30 17(2) 24/08/09 have the training they need to do their jobs effectively. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Each person’s care plan should be kept under review and revised, with them, as may be necessary when their needs change. Wherever possible, people or someone close to them should be invited to sign their care plan to show they agree with it so they always receive personal care in the way they want and prefer This will help to make sure that people always get care and support in a way they want and prefer. 2 OP9 Detailed records of the stocks of loose medicines need to be kept, including adding the amount of any new stock of a medicine to the existing balance, so managers can conduct thorough medicines audits and ensure stocks are maintained at the appropriate levels. This will help to ensure that the people who live at the home are protected and receive their medicines in accordance with their needs. 3 OP16 The record of complaints made by people who live at the home or their representatives needs to include details of all complaints made under the complaints procedure including the action taken to address the complaint and the outcome of any investigation. This will help to make sure that people are listened to and their views are taken seriously and acted upon. 4 OP33 The home’s quality assurance systems should be put into practice so people know they are listened to and their views are taken seriously and acted upon. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 32 5 OP35 Clear accounting procedures for handling people’s money should be set up including keeping receipts for purchases made on a person’s behalf so staff understand the way things should be done to protect themselves from accusation and protect the financial interests of the people who live at the home. Ashfields Care Home DS0000062416.V376327.R01.S.doc Version 5.2 Page 33 Care Quality Commission North West Region Citygate Gallowgate Newcastle upon Tyne NE1 4WH National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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